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Self-Assessment Questions

Pediatric Medicine

Pediatric Hospital Medicine: Review Questions

Michael P. Lukela, MD

Dr. Lukela is an assistant professor, Departments of Internal Medicine and Pediatrics,
and director of the Combined Internal-Medicine Pediatrics Program,
University of Michigan Medical Center, Ann Arbor, MI.

Choose the single best answer for each question.

1. A 14-year-old girl with mild persistent asthma is admitted to the hospital for an acute exacerbation. She is started on supplemental oxygen, oral prednisolone (1 mg/kg), and albuterol nebulized mist treatments every 3 hours. During morning rounds, she reports worsening subjective dyspnea. On physical examination, the patient’s temperature is 99.2°F, heart rate is 110 bpm, respiratory rate is 20 breaths/min, blood pressure is 128/88 mm Hg, and oxygen saturation is 98% on 2 L per nasal cannula. She is alert but appears uncomfortable. Of the following, which sign or symptom is most concerning for impending respiratory failure?
  1. Ability to speak in full sentences without pauses
  2. Diffuse symmetric end-expiratory wheezing on lung examination
  3. Diminished symmetric breath sounds without wheezing on lung examination
  4. Presence of symmetric, fine basilar crackles that clear with coughing
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2. A previously healthy 15-year-old girl is admitted to the hospital following an ingestion of a bottle containing unknown pills. Results of laboratory testing reveal a serum sodium level of 142 mEq/L, potassium level of 3.3 mEq/L, chloride level of 102 mEq/L, and bicarbonate level of 10 mEq/L. An arterial blood gas shows a pH of 7.32 and Pco2 of 12 mm Hg. Which of the following best describes the acid-base disorder that is present in this patient?

  1. Anion gap metabolic acidosis
  2. Anion gap metabolic acidosis and metabolic alkalosis
  3. Anion gap metabolic acidosis and respiratory acidosis
  4. Anion gap metabolic acidosis and respiratory alkalosis
  5. Nonanion gap metabolic acidosis
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Questions 3 and 4 refer to the following case.

A previously healthy 3-month-old infant born at term is admitted to the hospital with a 2-day history of acute gastroenteritis. The parents note that he has had little interest in breast-feeding and will not take breast milk or formula from a bottle. He is alert but irritable with a weak cry. Physical examination is notable for a slightly sunken anterior fontanelle, dry mucous membranes, diminished skin turgor, and capillary refill of 2 seconds (normal, < 2 sec). The serum sodium level is 136 mEq/L.

3.  This patient’s volume status is most consistent with which of the following?
  1. Euvolemia
  2. Hypervolemia
  3. Mild dehydration
  4. Moderate dehydration
  5. Severe dehydration
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4. What is the most appropriate initial hydration strategy for this patient?

  1. Oral rehydration with breast milk or formula
  2. Intravenous (IV) fluid bolus of 5% dextrose in water at 10 mL/kg
  3. IV fluid bolus of 0.25 normal saline at 10 mL/kg
  4. IV fluid bolus of 0.45 normal saline at 10 mL/kg
  5. IV fluid bolus of 0.9 normal saline at 10 mL/kg
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5. A previously healthy 16-year-old boy is admitted for observation following an episode of syncope during a soccer game. He currently feels well and is asymptomatic. The syncopal event was witnessed, and there was no antecedent trauma or seizure-like activity during or following the event. He has previously felt lightheaded during strenuous exertion but has never experienced syncope. He takes no prescription medications or herbal remedies and denies use of illicit drugs. Physical examination is unremarkable. Blood urea nitrogen, serum creatinine, and serum electrolytes, including potassium, magnesium, and calcium, are normal. Of the following, which finding or symptom is associated with a higher risk for sudden death?

  1. A personal history of classic neurocardiogenic syncope
  2. A family history of coronary artery disease in the patient’s grandparents
  3. Exertional chest pain not affected by movement
  4. The finding of an isolated inverted T wave in lead V1 on an electrocardiogram
  5. The presence of symptomatic orthostatic hypotension
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